Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.24 / $49.21 / $113.04	Facility	26	$41.24	$49.21	$113.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.69 / $136.11 / $209.35	Professional		$100.69	$136.11	$209.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $44.16 / $68.28	Professional	26	$37.65	$44.16	$68.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.99 / $86.91 / $139.22	Professional	TC	$63.99	$86.91	$139.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.68 / $143.37 / $215.77	Professional		$103.68	$143.37	$215.77
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.15 / $50.34 / $77.23	Professional	26	$38.15	$50.34	$77.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.97 / $90.32 / $139.91	Professional	TC	$66.97	$90.32	$139.91
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $144.69 / $158.06 / $282.16	Professional		$144.69	$158.06	$282.16
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $40.31 / $40.31 / $78.59	Professional	26	$40.31	$40.31	$78.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $104.39 / $104.39 / $203.56	Professional	TC	$104.39	$104.39	$203.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.19 / $177.76 / $320.08	Professional		$114.19	$177.76	$320.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.35 / $62.74 / $103.89	Professional	26	$42.35	$62.74	$103.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.75 / $114.37 / $220.31	Professional	TC	$67.75	$114.37	$220.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.32 / $135.01 / $171.78	Professional		$112.32	$135.01	$171.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.57 / $48.88 / $60.52	Professional	26	$39.57	$48.88	$60.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.65 / $85.59 / $111.27	Professional	TC	$72.65	$85.59	$111.27
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $47.22 / $60.00 / $117.12	Facility	26	$47.22	$60.00	$117.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $119.18 / $283.00	Professional		$60.00	$119.18	$283.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $56.88 / $158.07 / $295.35	Professional		$56.88	$158.07	$295.35
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $45.51 / $63.36 / $99.33	Professional	26	$45.51	$63.36	$99.33
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $146.00 / $205.32	Professional	TC	$79.45	$146.00	$205.32
United Facility/Professional Professional Modifier Low / Median / High Price $94.41 / $167.27 / $275.52	Professional		$94.41	$167.27	$275.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.59 / $63.44 / $92.92	Professional	26	$37.59	$63.44	$92.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.68 / $104.71 / $182.63	Professional	TC	$59.68	$104.71	$182.63